CAJ | 학술논문

目的：探讨主动脉腔内修复术对于B型主动脉夹层患者主动脉腔内修复术前、术后肾动脉血流及肾脏功能的影响。方法选择B型主动脉夹层患者110例，根据男性肾动脉受累类型不同分为ⅠA组（单侧或双侧肾动脉均为动力型缺血）10例、ⅠB组（单侧肾动脉为静力型缺血）36例、ⅠC组（双侧肾动脉为静力型缺血）8例；根据男性肾动脉受累数目分为双侧肾动脉未受累（未受累组）20例、单侧肾动脉受累（单侧受累组）38例、双侧肾动脉受累（双侧受累组）34例；根据女性肾动脉受累数目分为双侧肾动脉未受累（未受累组）8例、单侧肾动脉受累（单侧受累组）7例、双侧肾动脉受累（双侧受累组）3例。术前及术后观察双侧肾动脉的缺血情况及肾功能检查指标。并将各项指标进行对比。结果220支肾动脉中动力型缺血共42支（19．1％）；静力型缺血共80支（36．4％），主动脉腔内修复术后肾动脉动力型缺血全部得到显著改善，静力型缺血者可得到不同程度改善。随着肾动脉受累数量的增加，男性或者女性患者的肾功能受累情况呈进行性加重，且术后较术前呈下降趋势。结论对于B型主动脉夹层患者，主动脉腔内修复术能够开大主动脉真腔，提升肾动脉灌注，改善患者肾功能情况。
목적：탐토주동맥강내수복술대우B형주동맥협층환자주동맥강내수복술전、술후신동맥혈류급신장공능적영향。방법선택B형주동맥협층환자110례，근거남성신동맥수루류형불동분위ⅠA조（단측혹쌍측신동맥균위동력형결혈）10례、ⅠB조（단측신동맥위정력형결혈）36례、ⅠC조（쌍측신동맥위정력형결혈）8례；근거남성신동맥수루수목분위쌍측신동맥미수루（미수루조）20례、단측신동맥수루（단측수루조）38례、쌍측신동맥수루（쌍측수루조）34례；근거녀성신동맥수루수목분위쌍측신동맥미수루（미수루조）8례、단측신동맥수루（단측수루조）7례、쌍측신동맥수루（쌍측수루조）3례。술전급술후관찰쌍측신동맥적결혈정황급신공능검사지표。병장각항지표진행대비。결과220지신동맥중동력형결혈공42지（19．1％）；정력형결혈공80지（36．4％），주동맥강내수복술후신동맥동력형결혈전부득도현저개선，정력형결혈자가득도불동정도개선。수착신동맥수루수량적증가，남성혹자녀성환자적신공능수루정황정진행성가중，차술후교술전정하강추세。결론대우B형주동맥협층환자，주동맥강내수복술능구개대주동맥진강，제승신동맥관주，개선환자신공능정황。
Objective To study the effect of thoracic endovascular aortic repair (TEVAR) on renal artery blood supply and renal function in type B aortic dissection patients .Methods One hundted and ten B type aortic dissection patients were divided into ⅠA group (with dynamic ischemia of bi-lateral renal arteries ,n=10) ,ⅠB group (with static ischemia of unilateral renal artery ,n=36) ,ⅠC group(with static ischemia of bilateral renal arteries ,n=34)according to the involved renal arteries in male patients ,and intoⅡA group(without involvement of bilateral renal arteries ,n=20) ,ⅡB group (with involvement of unilateral renal artery ,n=38) ,ⅡC group(with involvement of bilateral renal arteries ,n=34) according to the involved renal arteries in female patients .Ische-mia in bilateral renal arteries and renal function before and after operation were observed and compared .Results Of the 220 renal arteries ,42 (19 .1% ) had dynamic ischemia and 80 (36 .4% ) had static ischemia .Both dynamic and static ischemia were improved after operation .The renal function progressively dcereased in male or female patients with the involvement of their renal ar-teries .Conclusion Thoracic endovascular aortic repair can enlarge the aortic lumen ,improve the renal artery blood supply and renal function in type B aortic dissection patients .